Prescription Drug Addiction: Signs and Side Effects of Prescription Drug Abuse

Prescription drug addiction refers to the compulsive use of medications for nonmedical purposes and in ways not intended by the prescribing medical professional. This addiction is often defined by continuous abuse despite serious harm or implications in an individual’s life and health. Prescription misuse can involve taking higher doses, taking medication more often, using someone else’s prescription, mixing medications with alcohol or using pills to get high.

The most commonly misused prescription drug categories include:

• Opioids: OxyContin or Percocet (oxycodone)
• Benzodiazepines: Ativan (lorazepam) or Xanax (alprazolam)
• Stimulants: Adderall (amphetamine) or Ritalin (methylphenidate)
• Prescription sleep medications: Ambien (zolpidem) or Lunesta (eszopiclone)

Informal street names for these drugs include pain pills, benzos, stims, study drugs, downers and sleep meds. Be careful buying medication from nonmedical sources. Medications purchased from illegal sources may be counterfeit and might contain unexpected and dangerous substances that increase overdose risk.

This article explores prescription drug addiction, including why they can be addictive, side effects and withdrawal symptoms. It explains signs and health effects but doesn’t discuss treatment or rehab.

While different prescription medications act on different parts of the brain, most affect the brain’s reward system and increase dopamine levels. Regular release of dopamine can lead to neural changes in the brain and cause a person to crave and seek out the drug, reinforcing continued use.

When people continue to take the medication, the reward system is repeatedly activated, leading to positive psychological effects that vary depending on the specific type of medication. However, for all medications, the reward cycle is similar and, once activated, can lead to increased misuse and eventual physical dependence and addiction.

The short-term relief a drug can provide can also entice people to abuse prescription drugs. For example, prescription painkillers may be used for pain relief, while sleep medications might help people relax and fall asleep. Those abusing attention-deficit hyperactivity disorder (ADHD) stimulant medication may find it easier to focus on tasks or excel in the workplace.

Tolerance and Addiction

Misusing most, if not all, prescription drugs and some over-the-counter abuse medications can lead to tolerance. Tolerance develops when the brain and body require more of the substance to achieve the same effects. As people take more of the drug, the risk of physical and psychological dependence increases.

Withdrawal and Addiction

When someone becomes dependent on a drug, they may experience unpleasant withdrawal symptoms that can range from mild to severe. Withdrawal can trigger ongoing use to keep the body from experiencing negative symptoms, especially when they’re uncomfortable or even dangerous. For example, someone might experience extreme rebound anxiety from Xanax abuse and withdrawal but choose to continue using the drug to relieve that feeling.

It’s important to note that using medications in risky ways, such as crushing pills, snorting, mixing substances or taking multiple prescriptions together, increases addiction and overdose risk.

There’s a difference between prescription drug abuse and when someone becomes physically and psychologically addicted to these substances.

Abuse

Now referred to by clinicians as “misuse,” abuse is when a person takes prescription drugs outside medical guidance, including taking higher doses than prescribed, using them longer than directed or taking someone else’s pills. People may also buy counterfeit substances when their prescription runs out or they can’t obtain the medication through legal means.

Addiction

Addiction is now referred to as “substance use disorder (SUD)” by clinicians to reflect the fact that it’s a treatable brain disease and not a personal choice. It involves the compulsive use of a substance, with loss of control, cravings and continued abuse despite negative social, emotional or physical consequences. People might center their lives around obtaining, using and then withdrawing from the drug, and their behavior may change.

Misuse can start as self-medicating, such as taking extra pills for pain, stress or sleep, and then progress into a pattern that’s hard to stop and builds tolerance and physical dependence. For example, someone may take more of an opioid prescription following an injury or misuse stimulants to cram for a test or a big work presentation.

Physical dependence happens when the brain and body adapt to regular exposure to certain medications, leading to withdrawal symptoms when use is reduced or stopped. Psychological dependence occurs when a person relies on medication to function, feel normal or cope emotionally.

Dependence risk increases with higher doses, more frequent or long-term use and certain drug classes, such as opioids, benzodiazepines and sleep medications. While dependence isn’t the same as addiction, it can be an early sign of a growing problem.

Common signs of prescription drug addiction include:

• Behavioral signs: These signs may include taking more of the medication than intended, doctor shopping, seeking early refills, hiding use from others, buying pills in between refills, stealing medication or forging prescriptions.
• Physical signs: Every drug elicits different physical signs. A few common signs include sedation, pinpoint pupils, changes in sleep, appetite changes, tremors, increased energy, euphoria or agitation.
• Cognitive and psychological signs: Cognitive signs can include poor decision-making, memory problems, mood swings, increased anxiety between doses, cravings and preoccupation with obtaining and using the drug.
• Social and functional signs: These signs are often most obvious and may include missing responsibilities at work or school, relationship conflict, declining work or school performance and legal or financial issues.
• Pattern signs: The pattern refers to how you use the drug and may include regularly increasing doses, mixing medications for a more intense effect or high, using pills to cope with stress or taking them in risky ways, such as crushing and snorting them.

Prescription drug withdrawal symptoms depend on the medication class and how your brain or body adapted to it.

Opioids

Opioid withdrawal signs include:

• Aches
• Sweating
• Runny nose
• Nausea
• Increased pain
• Insomnia

Sedative-type drugs

Withdrawal symptoms associated with sedative-type drugs include:

• Rebound anxiety
• Insomnia
• Restlessness
• Agitation
• Tremors
• Seizures

Stimulants

Stimulant withdrawal symptoms include:

• Extreme fatigue
• Low or flat mood
• An increased need for sleep
• Increased food intake
• Intense cravings

Withdrawal intensity varies based on dose, duration, frequency, drug type and polysubstance use, such as mixing alcohol with the prescribed medication.

Side effects of prescription drug abuse can range from mild to severe, depending on the medication category and level of dependence.

These side effects include:

• Opioid side effects: Slowed breathing, sedation, constipation, overdose and increased risk when mixed with alcohol or benzodiazepines
• Benzodiazepine and sleep medication side effects: Impaired coordination, drowsiness, memory issues, falls, complex sleep behaviors and increased overdose risk when mixed with depressants
• Stimulant side effects: High blood pressure, rapid heart rate, insomnia, anxiety, weight loss, paranoia and stroke risk at higher doses

General risks of prescription drug abuse include impaired driving, accidents, risky decisions, worsening mental health conditions and polysubstance overdose risk. Long-term risks include increased tolerance, dependence and escalation to stronger substances.

Risk factors refer to traits or experiences that may predispose a person to addiction and increase their chances of developing a substance use disorder.

Common risk factors associated with prescription drug addiction include:

• Medical factors: Medical factors include long-term prescriptions, high doses, multiple prescribing healthcare providers and limited monitoring.
• Mental health factors: A preexisting mental health condition, such as anxiety, depression, post-traumatic stress disorder or ADHD, makes access to these drugs easier and can influence a person’s potential use and abuse.
• Behavioral factors: A tendency to self-medicate, such as using pills to cope with difficult emotions, pressure to perform well, impulsivity and polysubstance use, can contribute to addiction.
• Social factors: Having easy access to prescription drugs at home, peer pressure and a limited or nonexistent support system can all lead to addiction.
• Environmental factors: Environmental influences, such as high-stress work or school settings and unstable routines, may contribute to drug dependence.

Physicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to diagnose prescription drug addiction. They focus on patterns over time, rather than a single use incident, to evaluate how a person’s drug use impacts their mental, emotional, social and physical health.

Healthcare professionals evaluate the following to diagnose prescription drug addiction:

• Loss of control
• Intense cravings
• Increasing doses to achieve the desired effects
• Attempting to cut down or stop use without success
• Experiencing withdrawal symptoms
• Risky use
• Continued use despite negative consequences

The assessment typically includes a mental health screening and a review of the person’s medication history, dosing patterns and potential safety risks. Drug testing may also be used and can confirm exposure, but it can’t measure severity by itself. However, prescription monitoring can help clinicians identify risky use patterns.

Prescription drug addiction can happen to anyone, and you shouldn’t blame yourself because it isn’t a personal failure. If you or a loved one is dealing with addiction to prescription substances, it’s important to get professional help.

Help.org is a free and confidential resource that makes it easy to find and compare prescription drug addiction rehab centers that meet your needs and preferences.